Provider First Line Business Practice Location Address:
1995 SAINT MATTHEWS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29118-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-982-5225
Provider Business Practice Location Address Fax Number:
803-982-5505
Provider Enumeration Date:
01/13/2025